alcohol dependence

Answer 1

Question: Can you tell me about Chlordiazepoxide, Clomethiazole, Topiramate, and Gamma-Hydroxybutyric Acid (GHB)?
Answer:

Class: Benzodiazepine - GABA Agonists

Mechanism:

Increase chloride influx to hyperpolarize GABA receptors, leading to increased inhibition in the CNS

Use:

Chlordiazepoxide: For acute alcohol withdrawal, anxiety, insomnia, seizures, and muscle spasm

Clomethiazole: For alcohol withdrawal and insomnia

Topiramate: Used off-label for alcohol dependence (reduces cravings)

GHB: Used in certain settings for alcohol withdrawal (reduced abuse potential)

Side Effects:

Common: Anxiety, confusion (especially in the elderly), dizziness, drowsiness, fatigue, headache, hypotension, mood alteration

Important: Clomethiazole is structurally related to thiamine (B1)

Answer 2

Question: Can you tell me about Disulfiram?
Answer:

Class: Alcohol Antagonist

Mechanism:

Blocks the oxidation of alcohol at the acetaldehyde stage, inhibiting acetaldehyde dehydrogenase

Leads to accumulation of acetaldehyde in the blood, which causes unpleasant hangover-like symptoms when alcohol is consumed

Use:

Adjunct treatment for alcohol dependence

Side Effects:

Common: Alergic dermatitis, breath odor, depression, drowsiness, encephalopathy, fatigue, hepatocellular injury, decreased libido, mania, nausea, nerve disorder, paranoia, psychotic disorder, vomiting

Answer 3

Question: Can you tell me about Acamprosate?
Answer:

Class: NMDA Receptor Modulator

Mechanism:

NMDA receptor modulation (similar to amino acids like taurine and GABA)

Works by stimulating GABAergic inhibitory neurotransmission and antagonizing excitatory amino acids (like glutamate)

Use:

Prevention of relapse in alcohol dependence

Helps in maintenance of abstinence from alcohol

Side Effects:

Common: Abdominal pain, flatulence, decreased libido, skin reactions, vomiting, nausea, diarrhea

Answer 4

Question: Can you tell me about Nalmefene?
Answer:

Class: Opioid Antagonist

Mechanism:

Antagonist at the mu-opioid receptor (MOR): Prevents the binding of endogenous opioids (like endorphins) and exogenous opioids (morphine, heroin)

Reduces dopamine release in the mesolimbic system, helping to decrease cravings and alcohol consumption

Partial agonist at kappa-opioid receptor (KOR): Helps modulate stress and anxiety, and reduce dysphoric effects from alcohol withdrawal

Use:

For the reduction of alcohol consumption in patients with alcohol dependence, especially those with a high drinking risk without physical withdrawal symptoms

Side Effects:

Common: May include dizziness, nausea, headache, and drowsiness